Jordan Hospital chief maps pathway for success

Thursday

Jul 31, 2008 at 12:01 AMJul 31, 2008 at 5:01 PM

Jordan Hospital chief executive Peter Holden says steps to “relentlessly” improve clinical care will save the medical facility from the fate of many community hospitals: partnering with a larger hospital chain to survive.

Nancy Reardon

Jordan Hospital chief Peter Holden says steps to “relentlessly” improve clinical care will save the medical facility from the fate of many community hospitals: partnering with a larger hospital chain to survive.

The hospital plans to implement a standardized health care approach in September and open a psychiatric division for older people, or geri-psych unit, in October. Both are part of a strategic plan developed in March to streamline costs.

“If you relentlessly focus on improving clinical outcomes, the finances will improve over time,” Holden told The Patriot Ledger editorial board Tuesday. “We can and will compare our clinical outcomes to the best in the state and nation.”

Holden, who’s been on the job for eight months, launched a hospital reorganization in March after it failed to meet budget projections for fiscal 2007 and for fiscal 2008, which began Oct. 1. Four managers and six union employees were laid off in March.

The hospital reported a $2.3 million deficit in its operating budget in January for the first quarter ending Dec. 31. But its year-to-date deficit improved to $1.7 million by the end of the third quarter in June, hospital spokeswoman Lucille Cassis said.

There are no plans for more layoffs, she said.

Jordan’s budget has been hit by the same factors plaguing many hospitals: declining Medicaid and Medicare reimbursements, costly free care services and declining inpatient and outpatient volume.

Jordan – the only hospital within 30 miles for the people in its primary market of Plymouth, Duxbury and Kingston, according to Holden – plans to open a 20-bed behavior health center by Oct. 1 to address the medical needs of elderly patients with diseases such as Alzheimer’s.

This new unit – located in a unit that was renovated – will bring the hospital’s total bed count to 179.

Jordan is projecting that the geri-psych unit will add 650 patients in fiscal 2009, Cassis said.

The hospital’s inpatient admissions declined 9 percent in fiscal 2008 over the previous year, which the hospital attributes to better medical management, Cassis said. She described this outcome as a “double-edged sword” because of its unintended effects on the operating budget.

The unit is part of a hospital mission to cater its service lines to community needs – a strategy that works, according to Joe Kirkpatrick, vice president of health care finance for the Massachusetts Hospital Association.

“Moving to recognize the senior population, which for people who are 75 and above is growing faster than the national average in Massachusetts, is essential,” Kirkpatrick said. “And further down toward the Cape is one of the fastest-growing areas.”

Jordan Hospital also plans to implement a “clinical pathway” approach to care, starting with pneumonia on Sept. 2.

The principle behind clinical pathways is that when each hospital physician approaches common ailments like pneumonia or a heart attack with different treatments, prescriptions and tests, it creates more room for error and may affect the patient’s care.

“It’s not cookbook medicine,” said Dr. Harvey Kowaloff, vice president of medical affairs, who is directing its rollout. Hospital staff from all related departments are involved in developing the pathway guidelines, he said, which are like blueprints.

The “clinical pathways” approach was developed in the 1980s at New England Medical Center. It’s a long-term approach to streamlining costs that many Massachusetts hospitals have adopted, Kirkpatrick said. “When the staff is used to the same procedure, there are fewer mistakes,” he said. “And mistakes are very expensive.”

Holden said he believes the pathways approach will be the biggest boost for Jordan.

“I believe we can absolutely improve our clinical outcomes, and I believe we can absolutely improve the treatment and diagnoses in our hospital,” he said.